Menu

Search for:

Look back on how leaders reacted to ebola in Liberia

Below are recent blogs about #ebola from http://crofsblogs.typepad.com/h5n1/ over the last 3 days. It is useful because it contains some unique information sources, not just the usual AP/Reuters/Time/CNN news regurgitation.

Twitter #ebola activity on October 4th explodes in USA after first domestic case reported.

A Uganda-born doctor, Dr. John Taban Dada, has become the latest health worker to fall died early Thursday of Ebola at the ELWA II Treatment Center.

Mr. Tolbert Nyenswah, Assistant Minister for Curative and Preventive Services at the Ministry of Health and Social Welfare told FrontPageAfrica Thursday that the gynecologist and surgeon was immediately buried Thursday in accordance with policies requiring quick interment of victims.

Dr. Dada reportedly tended to Rev. Napoleon Braithwaite, a Special Assistant to the Chief Medical Officer, Dr. Bernice Dahn, who died from the deadly virus on September 24, 2014. Dr. Dahn immediately placed herself under a 21-day quarantine.

Dr. Dada’s death brings to four the number of doctors who have died in Liberia since the outbreak. Over ninety health workers, including nurses and physician assistants, have also died.

Dada, a naturalized Liberian doctor who served as the medical director of the Redemption Hospital in Monrovia from 2008 to 2013 before moving on to take up a new assignment at the country’s largest hospital, the John F. Kennedy Memorial Medical Center.

Dr. Atai Omoruto, a Ugandan doctor heading the newest Ebola treatment center at what used to be Island Clinic in the western suburbs of the city, expressed shock at the death of Dada, describing him as a very quiet and dedicated man.”I didn’t know he has passed on; it is really unfortunate that we’re still losing so many health workers,” she told the Associated Press.

“This Ebola really … it has come for the health workers,” she said, “Because right now at Island Clinic we have almost 10 health workers admitted including doctors from JFK and laboratory technicians and nurses.”

Through radio programmes, psychosocial support and training women’s networks, UN Women is supporting efforts to address the gender dimension of the Ebola crisis in Liberia.

Radio host Justice Clarke and his guests sit in a semi-circular United Nations radio studio for a live discussion of ‘Ebola and Stigma’. This is a special edition of the UN Women-sponsored 12th Man radio talk-show, produced in partnership with UN Radio in Liberia — a show devoted to promoting men’s role in ending sexual and gender-based violence and helping empower women and girls.

However, considering the devastating emotional and psychological effects of the Ebola outbreak, the programme was modified to provide psychosocial support, targeting patients, health workers and the public, with a specific focus on the needs of women. Radio spots with messages on ending violence against women were also aired throughout the discussion.

“We know very well how the Ebola crisis is having a huge impact across the Liberian society. Think about the immediate benefit of psychosocial response,” said Francesca Crabu, Clinical Psychologist for the International Committee of the Red Cross in Liberia. “We see very quickly how even 20 minutes of intervention can lead to change in behaviour and one’s way of thinking. We are building resilience at community-level.”

Engaging women in community-based Ebola awareness

Preliminary data from Liberia’s Ministry of Health and Social Welfare showed that women accounted for between 55 to 60 per cent of Ebola related deaths, with the rate of infection of women at that time much higher than men. This is due to women’s roles as caregivers, nurses and cross-border traders. In rural areas, where the majority of smallholder farmers are women, food production is almost certain to drop, while the closure of borders is affecting cross-border traders, the majority of whom are women.

At least 50 representatives from partner institutions of UN Women and the country’s Gender and Development Ministry have been trained to raise awareness on the Ebola Virus Disease in various communities across Liberia.

“I found this training very helpful and educational especially in answering some of the doubts that we have in our community about Ebola. Now I am aware that bathing with salt solution or eating bitter kola (Garcinia Kola) cannot cure or prevent the spread of the virus. I have gained a lot of knowledge and I want to ask for more training about Ebola,” said​ Beatrice Joe, who took part in the Training of Trainers Ebola Workshop.

The training participants, 85 per cent of whom were women, learned different social mobilization skills aimed at providing Ebola prevention information to grass-roots women and reach the illiterate. The September training also focused on teaching the proper methods and formula for preparing chlorinated water for hand-washing and cleaning, how to use gloves or plastic bags to respond to suspected Ebola patients, what to do to prevent the spread of the virus as well as how to interact with survivors.

Dr. Gabriel Logan is a bundle of energy. Wearing a yellow dress shirt untucked from his slacks, he races around the Liberian government hospital compound in Tubmanburg, north of the capital, Monrovia.

He also moves fast on the medical front, experimenting with his own idea of treatment for Ebola patients.

Back in July this hospital, which was the main medical facility for the region, was closed after 10 of the staffers got sick with Ebola.

“We sent them to Monrovia,” he says. Of the 10, only one survived.

When the hospital reopened in August, Logan at first tried to refer any suspected Ebola cases to Monrovia. Clinics in the capital had no room for them.

“Everywhere is filled, so I said to myself, ‘Well then, as a doctor I have to do something to save some of the people’s lives,’ ” Logan says.

So Logan set up a bare-bones Ebola isolation ward in a small building behind the hospital. He also started wondering whether any of the drugs in his pharmacy might work against the virus.

That’s when he decided to try lamivudine, an antiviral medicine used to treat hepatitis B and HIV, on Ebola patients.

There’s no approved medicine on the market to treat Ebola, and lamivudine is not even on the list of the World Health Organization’s experimental prospects.

But Logan says he needs to do what he can now: “We need to save some of the lives of our people.”

Of the 15 patients he treated with lamivudine, he says, 13 survived. Logan acknowledges that this is far too small a sample to prove whether lamivudine is effective. But that’s not slowing him down.

“Do you expect me to wait until the bigger study is over?” he asks. “Then most of my patients would be finished. They would be dead.”

Ebola hasn’t just brought treatment challenges to Logan’s hospital. He’s also dealing with issues concerning the dead bodies. Body collectors are refusing to dig graves, saying it’s not their job. And new cemetery space needs to be found because the current plot is full.

In addition, Logan has to organize care for 24 orphans whose parents died of Ebola.

And if that wasn’t enough, he also has to combat fear of the hospital. Logan and his staff also treat people with illnesses other than Ebola, but patients are staying away. Just the word “Ebola” scares them.

“So we are out there talking to [the community], telling them there is hope,” Logan says. “If you are sick you need to come.”

The county has organized regular community meetings to handle questions about the outbreak. At a recent one, Logan tries to quash rumors that Ebola survivors are still infectious.

He’s confrontational with the crowd, but in a good-natured way. Logan is affectionately known as “G-Lo” around the hospital — a mashup of his first initial and Logan.

Logan insists that survivors provide inspiration to Ebola patients and should get jobs at the new treatment unit being built by U.S. troops on the hospital grounds. He assures a grumbling audience that survivors will just be doing ordinary housekeeping. “They will not be serving medication,” he says. “But they will be members of the team.”

Currently Logan has just six Ebola patients in his ward, but he expects he’ll need the full 100 beds in the facility being built by the Americans as this epidemic grows.

Dr. Paul Gully wanted to make a contribution. Dr. Eilish Cleary had practised before in West Africa and knew what it takes to work effectively there. And as West Africa’s Ebola epidemic continues to evade control, other Canadian medical professionals are assessing the overwhelming need and thinking about whether they too should step forward.

International response agencies have been desperately seeking volunteers for some time to help to contain this unprecedented outbreak. One person involved in recruiting for the World Health Organization, Toronto physician Rob Fowler, estimates that by now dozens of Canadians have been deployed in various roles, through the WHO and non-governmental response organizations.

Still, back in the late spring and summer when Medecins Sans Frontieres first warned it could not handle this outbreak alone, the initial response to the calls for help was muted at best.

“People were really afraid about it and still people are afraid about it,” said Christophe Lefebvre, manager of placements for MSF Canada, which is also known as Doctors Without Borders.

The group has had 28 people from Canada who have gone or are training to go to West Africa to work on the organization’s response efforts. MSF has been sending doctors, nurses, psychologists and psychiatrists, as well as logisticians — people who can set up water systems for treatment centres and organize burial efforts as well.

The work is not for everyone, MSF and others stress. It is gruelling, dangerous and emotionally exhausting.

“On one project they had to bury quite a lot of people so they had to build a crematorium. And it’s very, very rare that we have to ask for people to do this,” Lefebvre offered as an example of how taxing the job is.

Still, people are coming forward.

Among them are 14 employees of the National Microbiology Laboratory in Winnipeg, who have gone in three- and two-person teams to operate a mobile diagnostic laboratory that Canada has donated to the response effort.

There have been six rotations since the first team deployed in June, and three of these people have been to the Ebola zone twice.

This commitment is being juggled with the need of the Winnipeg lab to do critical research aimed at speeding up the availability of Ebola drugs, as well as doing the required testing whenever an illness in a person coming to Canada from the affected countries sends up a “maybe Ebola” flare.

“We are being very careful to ensure that we keep adequate resources at home,” the agency said in an email.

In World Wars I and II, young Americans swarmed into Canada to sign up when their country was still neutral. In Vietnam, more Canadians went south to join the US Army than Americans came north to avoid the draft. One of those Canadian vets came home to one of my classes, showing me my first thousand-yard stare. It was not the last.

When you’re young and crazy and want to see what you’re made of, going into combat is an attractive choice. (If my father had made it to the International Brigades in Spain, I wouldn’t be here to tell you about it. Fortunately, he was thwarted.)

Ebola begins to look like a genuine Good War: horrible, violent, squalid, as harsh to the winners and their families as to the losers in Monrovia and Freetown—but a war that has to be fought. Compared to the ebolavirus, the monstrous tyrants of the 20th century like Hitler and Stalin could be reasoned with. Ebola can’t. We kill it, or it kills us.

Never mind the West African crooks skimming Ebola funds towards a down payment on a villa in France. Folks here at home are getting rich right now. Via South China Morning Post, a Reuters report: Ebola battle plays out in US options arena. Excerpt:

The newest twist in the business of trying to capitalise on the outbreak of the Ebola virus is playing out in the US equity options market.

Trading volumes have soared in the stock options of a pair of biotechnology companies thought to have promising treatments for the deadly disease that has claimed the lives of 3,865 people worldwide, according to the World Health Organisation.

Canada-based Tekmira Pharmaceuticals, which is said to be furthest along among the companies working on a treatment, and Chimerix, whose experimental oral antiviral drug was used on the first US victim of the disease, have seen a huge increase in trading activity in their stock options.

Investors have been using the options market as a cheap way to bet on further gains in those two stocks, as well as other biotech stocks.

“It’s just pure call speculators that hope that they [the companies] are going to find the cure and announce it tomorrow,” said J.J. Kinahan, chief market strategist at brokerage TD Ameritrade.

The flow of news about the spread of the Ebola virus globally has resulted in sudden and large moves in the share prices of biotech stocks.

On Wednesday, shares of Chimerix fell more than 18 per cent in 40 minutes after news of the death of Thomas Eric Duncan, the first person diagnosed with Ebola in the United States.

Chimerix’s drug, called brincidofovir, which is in late-stage testing, had been used in the treatment of Duncan, according to hospital officials in Dallas.

Tekmira’s stock gained about 13 per cent at the same time.

Tekmira’s drug TKM-Ebola was reportedly used in treating Rick Sacra, an American doctor who was flown back from Liberia to a medical centre in Nebraska. Sacra recovered, although doctors say it is not known what role the Tekmira drug played.

An NBC News freelance cameraman, Ashoka Mukpo, is also being treated in the Nebraska facility for Ebola and has reportedly received Chimerix’s drug brincidofovir.

Overall, Tekmira shares have risen about 126 per cent over the last three months while shares of Chimerix are up about 54 per cent in that time.

Trading activity in both the cash market and the options market has soared. Prior to August, Tekmira’s daily volume was about 515,000 shares, while Chimerix averaged 312,000 shares. Since then, the average has been 6.51 million shares to Tekmira and 966,000 for Chimerix.

The UN World Food Programme is continuing to scale up its operations to provide food to over 1 million people affected by the Ebola crisis in Guinea, Liberia and Sierra Leone.

The three pillars of WFP support in the Ebola crisis are to deliver food alongside the health response, ensure the movement of partner staff and equipment, and provide logistical services and infrastructure support for health partners.

With its operations across the three most affected countries, WFP seeks to reach patients in Ebola treatment centres, discharged Ebola survivors, communities with widespread and intense transmission, and the families of people infected with Ebola.

In Liberia, WFP is aiming to provide food to over 400,000 people in areas of widespread and intense transmission of the Ebola virus over coming months. So far more than 100,000 have been reached.

“Food assistance is crucial for families who have a member affected by the virus, or who are living in quarantined areas, as they have often lost a source of income and cannot buy food in the market,” said Wurie AlGhassim, deputy head of WFP’s Liberia office.

New food distributions are now starting in the northern Lofa County, where transmission of the virus has been widespread, and in the New Kru Town slum of the capital Monrovia, which has been similarly affected.

“It’s difficult. It’s not a food security or malnutrition crisis. We are used to handling that, whether it’s a conflict, earthquake, or natural disasters… This is human suffering at its most complicated. Everybody just does their best to treat the symptoms.

“As WFP, we are shifting gears and at the same time trying to keep up with the spread of the virus,” said Denise Brown, WFP Regional Director, after field visits to Liberia and Guinea.

Through WFP, the Logistics Cluster has established a hub in Monrovia with a storage capacity of 3,000 square meters. Exclusively dedicated to the Ebola response, it is already managing, dispatching, and tracking the health cargo stock of other humanitarian organizations. The Logistics Cluster is also providing unprecedented engineering support to the World Health Organization (WHO) in the construction of four new Ebola Treatment Units in Monrovia that will accommodate 400 beds.

I understand that when the US Army was about to go into World War I, it consulted the Jehovah’s Witnesses first. The Witnesses have always held frequent large conventions of believers, and by 1917 they were logistics masters who could efficiently feed thousands in one place.

The logistics of feeding a million people in West Africa must be a daunting one. Just thinking about the demands of getting food and medical care where they’re needed is beyond the ability of most of us wondering what to fix for dinner tonight. We are all lucky that some people have taken up the challenge.

The Assistant Physician at the Macauley Government hospital Tamba Abu was on Tuesday 7th October 2014 assaulted by some family members of a patient that was admitted on Sunday at the hospital.

In an exclusive interview with the Assistant Physician on Tuesday 7th October 2014 at his office at Macauley Street in Freetown, he told this reporter that he received a call by someone claiming to be one of the relatives of the patient on Sunday asking him if there is bed at the hospital.

He replied in the affirmative and the relatives brought the patient at the hospital with high fever. He said blood sample was taken from the patient and the results showed that the patient was infected with Ebola while he also discovered that the said patient was taking treatment at home for over 2 weeks.

Tamba Abu went on to say that they tried their best to treat the patient but it was too late as they did not bring the patient early for treatment which resulted in his demise on Tuesday 7th October 2014. The Assistant Physician Tamba Abu said that as soon as news went around that the said patient had died, relatives stormed the hospital and attacked him raining insults at him almost beating him up in the process, accusing him of killing their relative.

According to him, he tried to put the situation under control but to no avail as some of the assailants held offensive weapons and his life was threatened. In order to escape the mob, he had to call for more re-enforcement from the police as the security at the facility had been overwhelmed.

Tamba Abu said he will not relent to fight against the deadly Ebola virus as there are many challenges but they will make sure they defeat the Ebola virus out of Sierra Leone.

Tamba Abu said the Minister of Health and Sanitation called him and congratulated him for the good work he is doing at the Macauley Government hospital, noting it as a motivational booster.

A $1 billion United Nations appeal to fight Ebola has only been 25 percent funded and senior U.N. officials warned on Friday that no country was safe as the world faced a crisis with staggering potential.

“It is the most extraordinary challenge that the world could possibly face. You sometimes see films about this sort of thing and you imagine how could such a thing happen. This is more extreme than any film I have ever seen,” said Dr. David Nabarro, who is heading the U.N. response to the Ebola epidemic.

Nabarro has said a “20-fold increase” in the global response is needed compared to efforts at the end of August. The United Nations has established a special mission, known as UNMEER, to coordinate efforts to stop the spread of Ebola.

The current outbreak of the hemorrhagic fever, which is the worst on record, was identified in March in a remote part of Guinea and has spread to West African countries Sierra Leone, Liberia, Nigeria and Senegal. Cases have also been reported in Spain and the United States.

The World Health Organization, the United Nations public health arm, has said an Ebola outbreak in Democratic Republic of Congo is unrelated to the one in West Africa.

On Friday, WHO raised the death toll to at least 4,033 from 8,399 probable, suspected and confirmed Ebola cases.

Nabarro told a special briefing of the 193-member U.N. General Assembly that the disease was spreading so rapidly the number of cases was likely doubling every three or four weeks.

Maternal and infant deaths in Liberia and Sierra Leone are set to rise above their current alarming rates as fear of Ebola keeps pregnant women away from hospitals and makes already-scarce health workers reluctant to deliver babies.

“At the beginning of the outbreak, health service staff were the ones getting Ebola – many of them were dying. And they had no facilities to help sufferers. People grew terrified and when news spread, everyone got scared,” said the head of maternal health for the UN Children’s Fund (UNICEF) in Sierra Leone, Augustin Kabano. “Some centres have just two or three staff so if one dies, the whole system shuts down.”

Liberia and Sierra Leone already have some of the world’s worst maternal and infant death rates though they are better than they were: In 2010 some 890 women in Sierra Leone died per 100,000 live births, down from 2,000 ten years earlier. In Liberia 770 per 100,000 died in 2010, down from 1,100 in 2005, according to UNICEF. The improvements are linked to the introduction of free health care to pregnant, birthing and lactating women in public health facilities. Both countries had also upped the number of births attended by a health professional to 63 percent in Sierra Leone in 2012, and 46 percent in Liberia.

But when Ebola broke out in Sierra Leone in May, and Liberia in August, the number of births attended by a health professional in Liberia dropped from 52 percent to 38 percent, while the number of women in Sierra Leone attending hospitals and health centres to give birth has dropped by 30 percent, according to the countries’ respective Health Management Information Systems.

These attendance rates will increase maternal and infant death rates, said Kabano, though the extent of this will probably only become clear once studies take place (such as the government-UNICEF comprehensive health indicator study to be rolled out in Sierra Leone in 2015).

Fear on the part of health workers, combined with a shortage of midwives or doctors available to deliver babies, led to the death of expectant Fatumatta Fofana, a mother of five from Bushrod Island, a slum neighbourhood in Monrovia, according to her brother Mohammed Sheriff.

Fofana was turned away from her local clinic because there was no nurse or doctor available. She tried Redemption and JFK hospitals, but they, too, were closed because the government had temporarily shut down all state hospitals amid mass health worker deaths. Fofana finally turned to a small clinic called Muslim Clinic, but its administrator Alieu Konneh said he could not find a doctor who would come to help her deliver. Fofana died a few hours later and her baby did not survive.

Sheriff blames the government: “My sister get four children. I believe when the clinic was open, she could give birth easily but because government closed all the clinics, so she could not make it. I blame the government the way she died.”

JFK hospital has since reopened its maternity ward but only for patients receiving pre-natal care, as staff are too afraid to treat women in labour who may be Ebola-positive, said a doctor who preferred anonymity.

22 March 2014: the Guinea Ministry of Health notified WHO about a rapidly evolving outbreak of EVD [1]. The first cases occurred in December 2013. The outbreak is caused by a clade of Zaïre ebolavirus that is related but distinct from the viruses that have been isolated from previous outbreaks in central Africa, and clearly distinct from the Taï Forest ebolavirus that was isolated in Côte d’Ivoire from 1994–1995 [2-4]. The first cases were reported from south-eastern Guinea and the capital Conakry.

May 2014: the first cases were reported from Sierra Leone and Liberia [5,6] to where the disease is assumed to have spread through the movement of infected people over land borders.

End of July 2014: a symptomatic case travelled by air to Lagos, Nigeria, where he infected a number of healthcare workers and airport contacts before his condition was recognised to be EVD.

8 August 2014: WHO declared the outbreak a Public Health Event of International Concern (PHEIC) [7] and confirmed on 22 September that the 2014 Ebola outbreak in West Africa continued to constitute a Public Health Emergency of International Concern.

29 August 2014: the Ministry of Health in Senegal reported a confirmed imported case of EVD in a 21-year-old male native of Guinea.

18 September 2014: the United Nations Security Council recognised the EVD outbreak as a ‘threat to international peace and security’ and unanimously adopted a resolution on the establishment of an UN-wide initiative which focuses assets of all relevant UN agencies to tackle the crisis [8].

23 September 2014: A study published by the WHO Ebola response team forecasted more than 20 000 cases (5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone) by the beginning of November 2014 [9]. The same study estimated the doubling time of the epidemic at 15.7 days in Guinea, 23.6 days in Liberia, and 30.2 days in Sierra Leone.

30 September 2014: the US Centers for Disease Control and Prevention (CDC) announced the first imported case in US of Ebola linked to the current outbreak in West Africa.

3 October 2014: In Senegal, all contacts of the imported EVD case have completed a 21-day follow-up period. No local transmission of EVD has been reported in Senegal.

6 October 2014: The Spanish authorities reported a confirmed case of Ebola virus disease (EVD) of a healthcare worker who participated in the treatment in Spain of the second Spanish patient with Ebola infection repatriated to Spain.

Workers at Madrid’s Carlos III Hospital have seen off the president of the government, Mariano Rajoy, and the president of the Community of Madrid, Ignacio González, hurling latex gloves at the cars they were in after a visit with the Ebola patient Teresa Romero.

Others picked up the gloves and rubbed their faces with them, a gesture interpreted as a message of support for Romero; she had said she might have infected herself by touching her own face as she was removing her PPE.

I was a member of the team that investigated the first known outbreak of Ebola. It was in the Democratic Republic of Congo (DRC, then called Zaire) at the Yambuku Mission Hospital nearly four decades ago. By tracing contacts and dates of infection, we searched for the first person infected (possibly from the blood of a game animal butchered for food) who became a source of infection for others.

We concluded that this ‘index patient’ had been treated at the mission clinic for a nosebleed, and for dysentery with an injection. His visit was noted in an unremarkable entry on line 2,355 of an outpatient ledger.

The needles and syringes used at the hospital were shared with the maternity ward. Equipment was, at best, rinsed with distilled water between patients. Outpatients and pregnant women were infected by injections; health workers were infected by blood and bodily fluids from patients, and workers in turn infected family and community members.

The virus spread from that one index patient to 318 people, resulting in 280 deaths. The outbreak ended spontaneously, ironically hastened because the hospital closed after workers became infected or fled their posts.

Ebola flared the next year at the Tandala Mission Hospital in the north of the DRC, about 250 kilometres from Yambuku. I was based in Cameroon as an epidemiologist for the US Centers for Disease Control and Prevention. A colleague and I drove for two days across the Cameroon and Central African Republic on unpaved roads through tropical rainforest to investigate.

Although the index case in that instance had also received care at a poorly equipped hospital, a major outbreak did not occur. The physician in charge, a participant in the investigation at Yambuku, had suspected Ebola and isolated the patient, a nine-year-old girl. Only one more infection occurred — in the girl’s younger sister — and blood tests of hospital workers and the patient’s contacts found that the physician himself was carrying an antibody to Ebola, probably from a previous infection.

These early investigations revealed patterns. The first sign is often a cluster of people with diarrhoea or fever, lethargy and other symptoms sometimes confused with typhoid fever. Ebola emerges in rural settings; transmission occurs by contact with infected peoples’ blood and body fluids. Its spread is amplified by poor hospital practices (such as re-using needles) — health workers are at great risk of becoming infected and spreading the virus within hospitals and into their communities. Isolation can prevent hospital transmission, assuming that infection controls such as protective equipment and safe disposal practices are in place.

By 1995, when virologist Jean-Jacques Muyembe and I led the response to the Ebola outbreak at Kikwit General Hospital in the DRC3, we knew that rapid and robust action could stop spread, even along major transport links. (Kikwit is 350 kilometres — 5 hours by road — from the capital Kinshasa, where one patient travelled to and was rapidly identified and isolated.)

We also learned that communities clearly understood the risk of infection, and could be persuaded to forgo dangerous funeral rites, such as washing out deceased relatives’ mouths or clipping their fingernails.

Successful strategies

We had a three-pronged strategy. First, patients were identified and isolated, and protective clothing was provided to health workers. Second, contacts of all patients with Ebola were monitored, and their temperature taken twice a day for three weeks. Those with fever were isolated until diagnosis could be confirmed and those with Ebola were hospitalized. Third, individuals were educated to protect themselves and their families.

In this and several other outbreaks, organizations such as the Red Cross and the Red Crescent societies worked with village elders and chiefs to distribute information tailored to local traditions. Red Cross workers in protective gear provided transport for patients and burial services for the dead. When the hospitals were full in Kikwit, some patients were isolated in their homes. Their families were provided with protective clothing and monitored daily.

Peering inside a red Nissan hatchback that had pulled up to the gate of an Ebola treatment center here, a guard saw an older woman holding a tiny newborn, a young woman sprawled in the back seat and a man in his 60s crouched in the rear, gripping her clothing so she did not slide off.

The woman, the couple told aid workers who quickly gathered Saturday afternoon, was their daughter. She had been sick for a week and was bleeding profusely after giving birth prematurely about two hours before. Her boyfriend, the baby’s father, had recently been treated for Ebola, they added.

Workers asked the couple to wait outside the gate, where a masked man with a chlorine sprayer soaked the ground around them. Before sending the car to the triage area, a doctor opened a back door and saw no movement. Realizing he needed protective gear, he went to suit up, then examined the woman and pronounced her dead.

For her child, there were no clear protocols. No one touched the tiny girl, aside from the grandparents holding her. No one at the center had any experience in dealing with babies in the Ebola crisis, nor could they fully evaluate the dangers. They were caregivers, after all, at a place of last resort. In a country devastated by a terrible disease, where the fear of it is pervasive, what do you do with a vulnerable infant?

Liberia said on Friday it was banning journalists from Ebola clinics, defying media rights campaigners who have warned panicked African governments against “muzzling” reporters in response to the crisis.

Government spokesman Isaac Jackson made the announcement as he was questioned on a radio phone-in show about reporters being barred from covering a strike at a Monrovia Ebola treatment unit (ETU).

“Journalists are no longer allowed to enter ETUs. These journalists enter the ETUs and cross red lines,” Jackson, the deputy information minister, told listeners to commercial station Sky FM.

“They violate people’s privacy, take pictures that they will sell to international institutions. We are putting an end to that.”

Journalists had earlier been denied access to the Island Clinic in Monrovia to cover a nationwide “go slow” day of action by healthcare workers demanding risk bonuses for treating Ebola.

The minister told the Monrovia-based station he would insist that journalists report his statements from now on rather than what they saw for themselves.

“There is no protest, everything is fine with the healthcare workers and patients are well taken care of,” he said of the clinic.

Earlier, a caller identifying himself as a nurse at the centre told the station that patients had been dying because they were not receiving adequate care.

“We, the nurses, cannot work because the hygienists have stopped working. The patients are dying. Something needs to be done. The go-slow action is killing our people,” he said.

Sources from global aid agency Medecins Sans Frontieres (MSF; Doctors Without Borders), which runs a unit of around 250 beds in Monrovia, said it would be writing to the government to ask to be excluded from the ban.

Liberia is ranked 89th out of 180 countries in the 2014 press freedom index produced by Reporters Without Borders. Sierra Leone is 72nd while Guinea is ranked 102nd.

The media rights campaign group warned that panicked governments fighting the epidemic were “quarantining” reporters to prevent them covering the crisis.

“Combatting the epidemic needs good media reporting but panicked governments are muzzling journalists,” it said in a statement.

Isaac Audrick one of the drivers assigned to Chief Justice Francis S. Kporkor has been quarantined for a period of 21 days after the death of his wife who is reported to have died of illness suspected to be that of the deadly Ebola virus.

News of Isaac’s quarantine first broke out on Wednesday on the ground of the Temple of Justice but kept secret until it was confirmed by the Public Relations Department the high court Thursday morning to reporters seeking clarification on the matter.

Singbe Johnson, the Chief spokesperson for the department told reporters that news that one of the drivers to the Chief Justice has been quarantined for 21-days for observation as a preventive measure to establish whether the driver is in contact or not of the virus was true.

Johnson claimed that Isaac was quarantined because his wife had died from the virus while taking care of her sick mother who she did not observe that she was ill with the sickness that was discovered lately. The Judiciary Spokesperson Johnson said that Isaac was a weekend driver for the Chief Justice who had no interaction with the Chief Justice for the last two weeks when he observed that his wife had contracted the deadly virus.

“When the incident happened, it was Isaac who called to the Chief Justice that his wife had died from Ebola and asked the Chief Justice to excuse him from job to observe the 21-day quarantine which the Chief Justice endorsed” said Johnson.

He stated that the Chief Justice like any human was touched by the death of his driver’s wife and had sent over a condolence message to the driver and the rest of the family to take solace for the loss of his wife in this critical time of the Ebola crisis.

When quizzed whether if Isaac will return to the job and maintain his previous post as driver to the Chief Justice after observing the 21 days, Johnson replied in the positive and noted that the situation of Isaac could happen to anyone adding that the message is clear on the book that Ebola survivors and people who are quarantined because of Ebola should not be dismissed or stigmatized.

As the Ebola Virus Disease continues to wreak havoc in Monrovia and its environs, with more deaths and new infections, other parts of the country are carrying out frantic efforts to have the virus eradicated from the country.

One such area is Nimba County, which is recording massive reduction in new cases, the county health authority has said.

The Chief Medical Officer of Nimba County, Dr. Collins Bowah, told President Sirleaf during a visit to the G. W. Harley Memorial Hospital in Sanniquellie that the county has considerably reduced the transmission of the virus in the past few months through, what he termed, a collective fight.

The Liberian leader visited the county this Tuesday.

Providing an update on the Ebola virus disease and the general health care situation in Nimba, Dr. Bowah further disclosed that the Nimba County, has since the outbreak of the epidemic, registered 79 confirmed Ebola cases out of 249 probable and/or suspected cases with 49 deaths. Five of the deaths were healthcare workers.

Nimba is the second most populous county in the country behind Montserrado, and has several borders points with Guinea, from where the virus initially crossed over into Liberia last March.

Dr. Bowah told President Sirleaf about the need for the construction of an Ebola Treatment Center in the county. This would further enhanced reduction in transmission and also serve as a precautionary measure,

The Liberian leader welcomed news of the reduction in the Ebola cases in the county, but noted that that this achievement should not served as a room for complacency.

She further noted that there is still more to be done to have the disease eradicated from the county and the country at large.

President Sirleaf’s visit to Nimba was part of her ongoing motivational and acquaintance visits being made to health care facilities across the country in the wake of the outbreak of the Ebola virus disease now ravaging Liberia and its neighbors, Sierra Leone and Guinea.

This is encouraging, but WHO observed just yesterday that in Liberia “there is widespread under-reporting of new cases.” Good news, when associated with a political leader, is automatically suspect.

African leaders chided the international community on Thursday for its slow response to the Ebola crisis and appealed to the world to turn promises of aid into action on the ground.

In emotional appeals to a high-level meeting of major donors gathered at the World Bank, the leaders of the worst affected countries, Sierra Leone, Guinea and Liberia, said they needed everything from treatment centers to healthcare workers, equipment and funding.

“Our people are dying,” Sierra Leone’s President Ernest Koroma told the meeting in Washington via video conference. “Without you we can’t succeed, without your quick response a tragedy unforeseen in modern times will threaten the well-being and compromise the security of people everywhere,” he said.

The disease has killed nearly 4,000 people in the three west African countries, in the worst outbreak on record. Concern has spread after the first person diagnosed with Ebola in the United States died on Wednesday and the condition of a Spanish nurse infected with the virus worsened on Thursday.

Koroma appealed for more urgency from donors.

“The last few weeks have been weeks of massive concerns and commitments to the fight. However, the general international response has been slower than the rate of transmission of the disease,” Koroma said.

Liberian President Ellen Johnson Sirleaf, also speaking by video conference, listed her country’s vast needs and called for a “more timely and decisive response” by foreign governments.

She said that within the next month treatment and testing centers were needed, staffed by both local and foreign health workers, with more resources to set up community care centers, as well as help for healthcare workers dealing with non-Ebola patients.

“We need to ensure that it all comes together immediately,” Johnson Sirleaf said.

The WHO/CDC Budgets 2005 – 2013 chart details the annual budget of the CDC compared to the WHO operational spend. Note: The WHO calculations from 2009, 2007 and 2005 are calculated using biennial figures while the CDC budgets are exclusive of the Agency for Toxic Substances and Disease Registry (ATSDR) budget.

Daniel Flynn and Stephanie Nebehay raise a good point when they highlight the disparity between CDC and WHO total budgets. The standout data-points in this chart is the slide in CDC budget spend since the Global recession ($9-billion in 2007 reducing to 5.436-billion last year, a loss of 39.6%). At the same time the WHO expenditure has remained steadily above $2-billion per annum, an increase on its pre Global Recession spend.

Although the organisation has not had the massive cuts that the CDC experience in the post Global Recession economy it did not allocate enough of its budget to emerging diseases and according to the Reuters report its members did not approve of a $100-million budget to tackle epidemics in 2011.

What baffles me is that the funding was not reconsidered even after Middle Eastern Respiratory Syndrome Corona Virus (MERS-CoV) emerged out of Saudi Arabia in 2012 and then H7N9 the following year, this time out of China.

The second excerpt, this time looking at the WHO human capital response to the West African Ebola outbreak.

Francis Kasolo, head of a WHO regional Ebola response center set up in Guinea, said budget cuts forced AFRO to cut its epidemic team from 12 to four staff over the past two years. A 2011 proposal by a WHO committee for a $100 million task force to tackle epidemics that might have prevented Ebola spinning out of control was not approved by member states.

When Ebola struck, WHO’s international outbreak team in Geneva led by Fukuda was already swamped by outbreaks of MERS and H7N9 in China. Kasolo said the WHO brought in hundreds of foreign experts and health workers, paid for construction of Ebola clinics and supplied thousands of protective suits but it did not have the skills or personnel to run the centers, as MSF was asking.

“We’re a public health agency not a clinical management agency,” said Kasolo. “We don’t run hospitals but we can provide the necessary guidance on how the hospital should run.”

The WHO Employment by Contract Type 1999 – 2013 chart looks at the split between permanent and long-term contract personnel against those on short-term contracts. The numbers of staff are calculated as at 31 December each year.

Two data-points. As at the end of 2013, the WHO had 7,296 staff on its books and peaked in terms of staffing in 2009 when it recorded 8,660 staff. The other obvious trend is that over the past decade WHO has gone to some trouble to ensure that it limits the amount of temporary workers on its book.

WHO has cut 1,364 staff reduction since 2009 equating to 15.7% or roughly 4% per annum. It has been my experience that when large bureaucracies cut, especially if they request volunteer separation that they will lose a larger percentile of higher capability individuals (generally, talented individuals can move to new roles even in downturns.) So, that 15.7% cut in recent years would have come with a significant operational loss as the Reuters story clearly points out.

I’m also concerned that WHO currently has a permanent workforce of 88.4% against 11.6% temporary staffing. Workforces with permanency above 80% tend to more bureaucratic and process driven whereas WHO would be an organisation that would need to be lean and flexible.

The Austrian Red Cross is warning that black people are being unnecessarily stigmatised in Austria because of fears of an Ebola outbreak.

It points to anecdotal evidence such as black children being sent home from school if they have a cough, or neighbours panicking if a black person in their apartment block complains of a fever, according to Die Presse newspaper.

Gerry Foitik, an Austrian Red Cross rescue commander, said their fears are completely unfounded as the virus is transmitted by direct contact with infected blood, bodily fluids or organs, and people are only at risk of catching it if they have been in West Africa or had contact with someone who had Ebola. The incubation period can last from two days to three weeks.

Ebola symptoms include high fever, bleeding and central nervous system damage

“A black African who has been living in Austria for the past three weeks has the same risk of being infected with Ebola as a farmer from east Tyrol,” Foitik said.

He added that during the Sars crisis Asians were also stigmatised, and in the case of the Mers-coronavirus it will be the turn of people from the Middle East.

Ahead of deliberations by the 53rd National Legislature of Liberia on whether to grant President Ellen Johnson Sirleaf sweeping emergency power as requested by the Liberian leader in a letter to that body, condemnations have been pouring from Liberians about the presidential request with many describing the move as an attempt to return the country to anarchy and absolute dictatorship.

With the country struggling to cope with the worse ever outbreak of the deadly Ebola virus in history, the Government of Nobel laureate Sirleaf has been taking strange decisions such as the imposition of a state of emergency and a curfew, amongst other measures which it has claimed are all intended to successful fight the outbreak.

But fear gallops in Liberia Tuesday when the President wrote the national legislature seeking the endorsement of the body in granting her emergency powers to take decisions suspending at least four important provisions of the constitution of the country.

In the request by the President, she is requesting emergency powers to suspend articles 1, 12, 13, 15 and other provisions of the Liberian constitution that relate to the fundamental rights of the citizenry including the rights to freedom of expression, speech, protection against force labor, the right to elect officials, amongst other inalienable human rights .

While the country eagerly awaits discussion by the lawmakers on the President’s letter, fear, anger, condemnations are being expressed by several Liberians including politicians, civil society, organizations, ordinary Liberians both at home and aboard. Liberia’s former Auditor General John S. Morlu, II has described the President’s letter as the most devious attack on life, liberty and pursuit of happiness.

Morlu said “This is the most devious attack on life, liberty and pursuit of happiness. This is more than Decree 88A. Why will President Sirleaf decide to appropriate personal property in the midst of EBOLA…you mean she is going to take people clothes, cars and homes etc? People died in USA fighting for property rights and you want to bring that to Liberia? She knows why Americans hold dear the Second Amendment…it is exactly to defend against this form of government blatant attack on LIBERTY and PROPERTY”.

The former Auditor general wonders how the Liberian leader is going to control the media especially electronic when countries including North Korea and China have failed to do so.

“And how is she going to control electronic media when North Korea, The Islamic Republic of Iran, China etc., cannot with all their draconian laws. Not even Kadaffi, Mubarak or Sadam could control electronic media. So Ellen Johnson Sirleaf is going to restrict all Liberians in the Diaspora from writing on social media. I think she wants to jail RODNEY SIEH, again”, Morlu stated.

He called on Liberians to resist such power requested by the President should the Liberian Legislature, which stands accused of taking kickback to agree with the President on everything grants Sirleaf such power. “President Sirleaf told the Legislature she will send a brown envelope package to give her these rights. But all ‘Freedom Loving’ people MUST RESIST this Presidential overreach”, Morlu called on Liberians.

Workers of the Ebola burial team in the Western Area on 7th October 2014 downed tools over the non-payment of their two weeks risk allowances.

However, media reports yesterday claim that the workers have suspended their strike action until tomorrow when the Ministry has promised to pay them $200 each for two weeks.

Reports also alleged that the burial teams should have received their risk allowances since the beginning of October although they were paid till the end of September.

Each member of the burial team is supposed to receive Le400, 000 weekly but they last received their allowances at the end of September for which they have contacted the Ministry of Health and the Emergency Operations Center (EOC) on several occasions with nobody talking to them.

According to information reaching this medium, Health Ministry officials have held closed door meetings with the burial team to resolve the issue and recommence work.

The strike action on 7th October 2014 saw abandoned corpses on the streets of Freetown with nobody to collect them that further created panic among residents that Government is losing the battle against the outbreak with other residents warning that if Government does not address basic issues like prompt payment of allowances to health workers, it might send the wrong signal to the international community.

The Deputy Minister of Health II, Madina Rahman yesterday disclosed that Government has paid the allowances of the health workers into the bank that would take three days to process but could not state the reason for the delay which she promised to find out after a meeting yesterday morning.

It is not clear whether the workers will continue to risk their lives under difficult circumstances when some Government officials are attempting to frustrate the efforts of Government and the international community to contain the outbreak.

However, the head of one of the burial teams assured that he would continue to persuade his colleagues to resume work.

Health workers in Kenema that include nurses and laboratory technicians have threatened to down tools tomorrow if their four weeks backlog salaries are not paid.

I’ve finally had a chance to catch my breath and re-read today’s October 8 Ebola SitRep. Here are a few points worth considering:

• The recent fall in Liberian cases reflects a failure of the reporting system: “It is clear from field reports and first responders that EVD cases are being under-reported from several key locations…”

• “…the situation in Liberia, and in Monrovia in particular, continues to deteriorate from week to week.”

• “In Liberia, a new EVD isolation centre was established in Maryland district. However, the number of beds currently available in Liberia and Sierra Leone still falls well short of the capacity required.”

• “Nationally, the situation in Sierra Leone continues to deteriorate, with an increase in the number of new confirmed cases reported over each of the past seven weeks.”

• In Guinea, Ebola transmission “is persistent … with approximately 100 new confirmed cases of EVD reported in the past week.” Cases are also turning up in eastern Guinea, near the border with Ivory Coast.

I worry a lot about Ivory Coast, and Ghana just beyond it. And if Ebola goes northeast into Mali and Central African Republic, we’re looking at a very long war indeed.

We seem to be reprising the Rwandan genocide of the 1990s, when the whole world knew what was going on, and watched it happen, and yet did nothing to stop it.

First we got reports of limits on media coverage of the Ebola outbreak. Now the Daily Observer has several stories on new powers that President Ellen Johnson Sirleaf is asking of Liberia’s National Legislature, while suspending scheduled senatorial elections: Here, here, and here.

Spanish-speaking countries have a term for this: autogolpe, a kind of government-instigated coup d’etat. However they get into power, some governments find their constitutional limits too constricting. They declare an emergency, as Sirleaf did in August, and then it’s just one damn thing after another.

Sirleaf’s government has not shown a lot of imagination in dealing with Ebola. First it shrugged the outbreak off as Guinea’s and Sierra Leone’s problem. Then Ebola got out of the backwoods and arrived in Monrovia. Sirleaf’s response to that was to try to quarantine the West Point slums. That lasted all of eleven days and cost one teenage boy his life when the army opened fire on protesters.

After years of civil war, Liberia had just begun to climb back when Ebola hit. Sirleaf was at least coping with the recovery.

But Liberian Ebola has outwitted the CDC and the great state of Texas, and it has clearly outwitted the Liberian government. Just as strong assertions require strong evidence, great demands for power require great vision and resources. Sirleaf appears to have neither.

If she can’t fight Ebola and run a democracy at the same time, she might do better to appeal to the UN for some kind of protectorate status, with a capable democracy stepping in to mind the store until the crisis is over.

The potential spread of Ebola into Central and Southern America is a real possibility, the commander of U.S. Southern Command told an audience at the National Defense University here yesterday.

“By the end of the year, there’s supposed to be 1.4 million people infected with Ebola and 62 percent of them dying, according to the [Centers for Disease Control and Prevention],” Marine Corps Gen. John F. Kelly said. “That’s horrific. And there is no way we can keep Ebola [contained] in West Africa.”

If it comes to the Western Hemisphere, many countries have little ability to deal with an outbreak of the disease, the general said.

“So, much like West Africa, it will rage for a period of time,” Kelly said.

This is a particularly possible scenario if the disease gets to Haiti or Central America, he said. If the disease gets to countries like Guatemala, Honduras or El Salvador, it will cause a panic and people will flee the region, the general said.

“If it breaks out, it’s literally, ‘Katie bar the door,’ and there will be mass migration into the United States,” Kelly said. “They will run away from Ebola, or if they suspect they are infected, they will try to get to the United States for treatment.”

Also, transnational criminal networks smuggle people and those people can be carrying Ebola, the general said. Kelly spoke of visiting the border of Costa Rica and Nicaragua with U.S. embassy personnel. At that time, a group of men “were waiting in line to pass into Nicaragua and then on their way north,” he recalled.

“The embassy person walked over and asked who they were and they told him they were from Liberia and they had been on the road about a week,” Kelly continued. “They met up with the network in Trinidad and now they were on their way to the United States — illegally, of course.”

Those men, he said, “could have made it to New York City and still be within the incubation period for Ebola.”

Kelly said his command is in close contact with U.S. Africa Command to see what works and what does not as it prepares for a possible outbreak in the area of operations.

The Foundation for International Dignity (FIND) has alarmed that President Ellen Johnson Sirleaf’s request for more power and suspending certain rights of the Liberian people is a dangerous sign and threat to the country’s democracy.

President Sirleaf has written the National Legislature to give her extra-constitutional powers by suspending about seven provisions of the Liberian Constitution, including Article 1 (Inherent rights of the people) and Article 15 (Freedom of expressing and free speech), among others.

Several citizens and human rights groups including FIND are appealing to the National Legislature not to consider the President’s request for absolute power to take unilateral decisions in the country.

“This is dangerous for our country,” [FIND Executive Director Roosevelt A. K.]Woods told journalists in Monrovia Wednesday (Oct 8). “Anything that has to do with absolute power that violates human rights is a bad sign for Liberia. She was elected to bring positive change, to restore hopes and not to dash them.”

The human rights advocate argues that President Sirleaf’s government’s recent continuous stance against free speech and press freedom is damaging the image of the country which she help build over the years.

The President must know that democracy will be threatened in Liberia when citizens and the press are not given the space to express themselves in an open way. The media, Woods indicated, has played in pivotal role in the war against Ebola and should not be distracted with constant harassments, threats and intimidation by the government.

“Without the media reporting the affairs of the country and the Ebola crisis, most of the international partners and support would not have come here to help,” Woods noted. “It is very wrong and unfair for this very press to be under threat. It will affect their work.”

Speaking further, the FIND Boss said the government must accept criticism to perform better in the national Ebola response, adding, the government cannot use force and guns, and silencing of the people with extra judicial powers to fight Ebola.

“No level of force against the people can fight Ebola,” Woods argued. “We frown on the curfew, we frown on the state of emergency, and we frown on military force.”

Rather, Woods calls for citizens’ engagement and the improvement of the health sector as well as a better welfare scheme for those working in the health sector.

“Any extra judicial power and siezing people’s rights will plunge the country back, and we are calling on the National Legislature not to give the president that power,” Woods continued.

“Power, in Article One of our constitution, belongs to the people. We have given the legislators our power to represent us…and they should use it wisely.”

The rate of infection of Ebola virus amongst residents of the Western Area is shooting up at an alarming rate that has caused many observers to tell this newspaper that they were bracing up for an impending catastrophe on the capital city of Freetown if the speed of infection does not slow down.

The number of laboratory confirmed cases in the Western Area is now said to have shot past the number recorded in total for Kenema district so far. Freetown now has 528 lab-confirmed cases which is almost 100 cases more than Kenema which has 431 lab-confirmed cases.

In fact, Western Area might soon top Kailahun’s 532 cases and become the area with the largest number of cases. Although the population for Western Area is much, much higher than Kenema or Kailahun, the rate at which the numbers shot up in recent weeks is what has caused concern.

Another concern has been an inability to restrict the movements of those households who are supposed to be under quarantine. When cases of Ebola are identified in a particular house, the movement of residents in that household automatically becomes restricted in order not to transmit the disease to other compatriots. According to the current State of Emergency Law, any home that has recorded a case of the Ebola disease, people living in the household should be quarantined and security forces are expected to surround that house to prevent further spread of the Ebola disease.

However, on the contrary in Constituencies 094 and 095 in the Western Rural District some houses said to have recorded cases of Ebola infection remain without movement of residents restricted.

At Lumpa, Morabi, 4 Mile and Kwama Communities all in Constituency 095 many households that have shown cases of Ebola infection are not quarantined and there are no security forces to restrict movement. Our undercover reporter witnessed this during a donation exercise of food items by Pastor Ben Margai, the African Director of Light of the World Ministry to houses that are said to be quarantined at Constituency 095.

During this donation exercise, Member of Parliament for constituency 095, Hon. Claude D. M. Kamanda who also doubles as the Chief Whip in Parliament led the exercise in order to ensure that his constituents get food supply. The people who are supposed to be quarantined were freely moving within their communities in search of food supply.

Aminata Kanu who lost her mother and is expected to be in her quarantined home at Baker Street in Lumpa community, was called up from another neighborhood to collect her food items when the team arrived at her residence.

“The absence of security forces at houses that have recorded Ebola cases is a serious threat to Freetown and the entire Rural District,” said a community member.

“Lack of police or military deployment at houses that have recorded Ebola cases have resulted to the disappearance of some of those quarantined at a house in the Morabi community where the residents locked down the house and escaped from being restricted” our source disclosed adding that if those escapees are Ebola positive, they will spread the virus to the areas they have gone to.

At Kwama community, some of the community people disclosed that the quarantined people are moving in and out of the community creating perpetual fear and panic for other residents.

Our reporter visited so many quarantined homes during this donation exercise and there were only two places quarantined that were having two security personnel per house. Interestingly, the officers were equipped with only ordinary police uniforms; no gloves, no face masks and no weapons.

A Muslim hospital at 555 Spot, at Lumpa and one house on the main Highway towards 4 mile opposite an NP fuel station were all without a single police presence.

SUAKOKO, Liberia — The dirt road winds and dips, passes through a rubber plantation and arrives up a hill, near the grounds of an old leper colony. The latest scourge, Ebola, is under assault here in a cluster of cobalt-blue buildings operated by an American charity, International Medical Corps. In the newly opened treatment center, Liberian workers and volunteers from abroad identify who is infected, save those they can and try to halt the virus’s spread.

It is a place both ordinary and otherworldly. Young men who feel well enough run laps around the ward; acrid smoke wafts from a medical waste incinerator into the expansive tropical sky; doctors are unrecognizable in yellow protective suits; patients who may not have Ebola listen to a radio with those who do, separated by a fence and fresh air.

Here are the rhythms of a single day:

7:20 A.M.

Soon after their arrival, about a half-dozen doctors and nurses gathered near whiteboards for the handoff from the night shift. There were 22 patients, and no deaths overnight. The center — which includes a triage area, a restricted unit for patients suspected of having Ebola infections and another for those in the grip of the disease — is not teeming like some clinics in Monrovia, more than four hours west. It is designed to accommodate up to 70 patients, but it is still scaling up after opening a few weeks ago and has just two ambulances to ferry patients. .

An 8-year-old boy had been too weak to lift a liter bottle of oral rehydration solution to his mouth through the night. Bridget Anne Mulrooney, an American nurse, reported that she gave him a smaller bottle and sheets to keep warm. A woman who had lost both her baby and husband to Ebola and was suspected of having the disease herself was refusing food and medications for symptoms and other possible illnesses, such as malaria. A man in his 70s, a talkative staff favorite, was now confused, his sheet covered in blood. He had been admitted four days earlier, but laboratory tests confirming an Ebola diagnosis had not come back yet. “I think he’s positive,” said Dr. Colin Bucks, an American. “I think this will be an end-of-life event.”

Eight patients needed intravenous fluids to combat dehydration. One patient was described as happy. Another was playing cards.

7:40 A.M.

Morning devotion began with a song and clapping, performed in triple time. About 18 local workers, most wearing rubber boots and blue hospital scrubs bleached so often that they were now pastel pink, danced and then prayed for God’s mercy on the treatment unit and those who worked there. Some folded their hands, sheathed in bright-colored gloves, at their heart. In unison, the Liberians sang, “Cover with your protective arms, O God.”

One year ago, she died from complications in childbirth, a killer that every month takes twice as many lives as the entire Ebola epidemic. ... Many of these success stories were made possible through international development aid for maternal health, which increased steadily from 2010 to 2015.

Widow of Ebola Victim, Mother of Five Cries For Assistance March 18, 2018

Her story is probably more mind grappling than some of the famous stories told about the ugly impact left behind by the world's worst deadly Ebola virus outbreak in West Africa, including Liberia in 2014. Liberia became the worst affected with more than 5000 deaths. For Shianeh, every year Decoration ...

One year ago, she died from complications in childbirth, a killer that every month takes twice as many lives as the entire Ebola epidemic. ... Many of these success stories were made possible through international development aid for maternal health, which increased steadily from 2010 to 2015.

Widow of Ebola Victim, Mother of Five Cries For Assistance March 18, 2018

Her story is probably more mind grappling than some of the famous stories told about the ugly impact left behind by the world's worst deadly Ebola virus outbreak in West Africa, including Liberia in 2014. Liberia became the worst affected with more than 5000 deaths. For Shianeh, every year Decoration ...